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Chest Pain Differential Diagnosis – Due to the vague nature of chest pain, it can be representative of a wide range of medical conditions.8 Chest pain differential diagnosis can be broken down into categories:

Cardiac : acute coronary syndrome, pericarditis, congestive heart failure, post-cardiac injury syndrome Hematologic : sickle cell anemia, pleural effusion Gastrointestinal : pancreatitis, inflammatory bowel disease, bacterial pleurisy Infections : abscesses to the liver, lung, or spleen, bacterial and viral infections

Other categories of chest pain differential diagnosis are iatrogenic, pulmonary, rheumatologic, and renal, Once a thorough examination has been performed, medical professionals should be able to accurately diagnose the causes of chest pain and recommend the appropriate treatment.

What are the three differential diagnosis for chest pain?

Patients with chest pain are a common and constant challenge to clinicians, whether in the office, clinic, urgent care or emergency department. The clinical presentations may be confusing, the differential diagnoses are myriad, and not all patients with chest pain will have a serious underlying etiology.

Lawsuits involving the care of patients with chest pain are frequent and make up the costliest group of malpractice cases in Emergency Medicine. The cornerstone of high-quality, defensible care consists of a systematic approach coupled with comprehensive documentation. Of the top 15 conditions that represent the majority of “failure to diagnose” cases in emergency medicine, there are three that most often present with chest pain: acute coronary syndrome (ACS), acute aortic dissection (abbreviated as AoD or AAD), and pulmonary embolism (PE).

ACS tops the list of most commonly missed diagnoses in acute care medicine. The crux of the problem is that patients do not arrive with an ECG in hand heralding their definitive STEMI, but instead present with a constellation of symptoms that are often atypical in nature.

• Although the most common symptom of acute MI is chest pain, one-third of patients present with symptoms other than chest pain.
• In addition, cognitive bias plays a significant role; practitioners tend to anchor on alternative diagnoses, especially in the relatively young.
• About 40% of patients with AAD die immediately due to rupture and hemorrhage, allowing no opportunity for life-saving intervention.

However, the diagnosis is unsuspected and delayed in more than one-third of patients who present with AAD; these delays and failures to diagnose are a major source of medical errors and litigation. It is in this group of AAD patients where the team has the unique opportunity to make the diagnosis, intervene earlier, and avoid costly medical errors and litigation.

1. Most deaths from PE are the result of diagnostic error, not therapeutic failure.
2. PE can be extraordinarily difficult to diagnose.
3. It takes focused, coordinated data gathering and medical decision-making to determine whether PE should be in the differential or if it can be reasonably ruled out.
4. More than any others, the use of two classic “bedside maneuvers” tends to mislead practitioners and can lead to chest pain malpractice claims.

The first is the GI cocktail ; the second is the elicitation of chest wall tenderness, These two bad actors alone are to blame for dozens, if not hundreds, of malpractice suits in emergency medicine across the nation. Let’s expose each of these sinister characters in turn.

1. The essence of liability reduction in the care of patients with chest pain is to construct a medical record that provides a thorough, clear and logical explanation for your thoughts and actions.
2. EMR systems can now incorporate clinical decision support systems that assist the clinician to achieve optimal documentation for patients with chest pain and other acute complaints.

The following are a few of the key items to address in the chart documentation.

What is non traumatic chest pain?

Non-traumatic chest pain is often caused by a build-up of cholesterol plaque or a blood clot in the arteries. Angina is caused by a temporary or partial blockage of the coronary arteries that supply blood (food and oxygen) to the heart muscle.

What is the differential diagnosis of atypical chest pain?

Causes of atypical angina – ‘Atypical angina’ is defined as chest pain not fully satisfying criteria for ‘typical’ angina but somehow consistent with cardiac ischaemic cause. Atypical chest pain is the most common symptom complained by patients referring to emergency department or family practitioner, and approximately two-thirds of them have non-coronary aetiology.

If we exclude myocardial ischaemia and infarction, the most common causes of atypical chest pain are diseases related to gastrointestinal tract, chest wall syndromes, pericardial diseases, and vascular diseases; other less common diagnoses include pneumonia, pulmonary embolism, lung cancer, aortic aneurysm, myocarditis, stress-related cardiomyopathy (also called ‘Takotsubo’ syndrome), aortic stenosis, herpes zoster, and cardiac masses.5 After ruling-out acute myocardial infarction and other life-threatening conditions, usually related to cardiovascular compartment, the prognosis is generally very good.

Physicians usually refer these patients to further ambulatory diagnostic evaluations, aware that in about 10% of these cases specific diagnosis will not be reached.6

What are the red flags for chest pain?

Immediate action required: Phone 999 immediately if: You or someone else has symptoms like: central chest pain or discomfort in the chest that doesn’t go away – it may feel like pressure, tightness or squeezing. pain that radiates down the left arm, or both arms, or to the neck, jaw, back or stomach.

What mimics angina?

LONG LIST OF AILMENTS CAN MIMIC THE PAIN OF ANGINA QUESTION: I’m writing concerning angina pectoris. How do you know whether you have that or false angina? I’m 17 years old and get these sharp chest pains off and on, especially during the summer. Sometimes it happens when I’m asleep and wakes me up.

• What should I do about this? – Ms.L.C.B.
• ANSWER: It’s really unlikely for chest pain in one so young to be heart related.
• Angina, you know, represents faulty circulation in the heart arteries, and although it may occur at rest in one form of it, the pain usually comes on during increased physical activity.Angina pain is quite recognizable.

It is the pressing type, described typically as having an elephant sitting on your chest. It continues until relieved by rest or special medicine. My best bet from this distance is that your pain results from one of a long list of ailments that can mimic angina.

1. That list includes rib inflammation, spinal arthritis, and pleuritis (lung lining inflammation).
2. Often such pain in one your age reflects chest muscle inflammation.
3. Any deep breathing or sudden changes in body position can bring it on.
4. It’s like being poked in the chest by a sharp stick.
5. Perhaps you are more physically active during the summer and are straining muscles, with this being the only sign of it.

All this iffiness doesn’t get us anywhere. Since you are worried about this pain, settle the issue with your family’s doctor. At the very least, he can rule out your heart fears. And don’t feel embarrassed. It often takes an expert to sort out the trivial causes of chest pain from the serious ones.

• A somewhat related question from J.I.): QUESTION: My doctor said I had variant angina, which he is treating with calcium medicine.
• Is this different from regular angina? – J.I.
• ANSWER: As noted in the above item, so-called regular angina (heart) pain occurs from activity, and has its genesis in blockage of heart arteries.

The heart simply cannot keep up with circulation demands of the moment. Variant angina is aptly named, causing the same type of pain, but for a different reason, namely spasm of those arteries. And this usually occurs at rest, even when asleep. But the distinction is not always absolute.

Some people may have elements of both causes – the blockage and the vessel spasm. Your medicine, a calcium channel blocker, helps by relaxing the vessels, thus discouraging the spasms. But it is important to determine whether or not artery blockage is contributing and to alleviate that as much as possible by reducing dietary fats and cholesterol, etc.

QUESTION: Can you tell me what campylobacter gastritis is? How is it contracted and how treated? – D.L.M. ANSWER: Campylobacter (CAM-pill-o-BACK-ter) is a group of bacteria, only recently appreciated for its mischief potential. One kind (C. jejuni) causes diarrhea and stomach cramps.

• Another (C.
• Pylori) is sometimes found with stomach inflammation and ulcers.
• Nausea, heartburn and belching are other symptoms of that.
• These bacteria are active in unsanitary milk, water and foods, with poultry a favored host.
• Antimicrobics such as erythromycin and metronidazole are used to treat the infections.

Sometimes people have an infection with this germ that clears up on its own. QUESTION: Please tell me something about this cranberry juice kick that everyone is on. They tell me their doctors tell them to drink it for their kidneys. What do you think? – A.H.

ANSWER: The cranberry kick, as you put it, has a rationale, in that the juice contains hippuric acid. That makes urine more acid and less likely to form a haven for germ multiplication. In short, the cranberry advice is given to people who tend toward urinary bladder infections. I must say, though, that some authorities accept the cranberry story with a grain or two of the proverbial salt.

You do have to drink prodigious amounts for any appreciable effect. If you like the juice, fine. Good hydration is of itself healthful for the same goal. C) 1990 North America Syndicate Inc. : LONG LIST OF AILMENTS CAN MIMIC THE PAIN OF ANGINA

What is the 10 for atypical chest pain?

What are the causes for atypical chest pains? Common causes for atypical chest pain include gastrointestinal, respiratory and musculoskeletal diseases. It is also not uncommon for people with anxiety or panic attacks to think they’re having a heart attack.

How to tell the difference between cardiac chest pain and normal chest pain?

Symptoms of a heart attack – Typical heart pain is a dull, pressure-like or burning sensation. Some people describe a heart attack as feeling like “an elephant is sitting on my chest.” It is sometimes associated with shortness of breath. Heart pain may radiate to the left arm or neck.

1. If your pain is on your right side, a heart attack is unlikely.
2. Heart attack pain may start with chest pressure that comes and goes, sometimes with exertion.
3. If the pain becomes continuous, seek medical attention immediately and consider calling 911.
4. If you have chest pain constantly for several days, weeks or months, it is unlikely to be caused by a heart attack.

Heart pain is usually not sharp or stabbing. In general, any pain that gets worse with movement is not from the heart. Chest pain that is aching, sharp or stabbing, may be caused by other conditions such as acid reflux or heartburn, pleurisy or joint and muscle pain.

What is the differential diagnosis of atypical chest pain?

Causes of atypical angina – ‘Atypical angina’ is defined as chest pain not fully satisfying criteria for ‘typical’ angina but somehow consistent with cardiac ischaemic cause. Atypical chest pain is the most common symptom complained by patients referring to emergency department or family practitioner, and approximately two-thirds of them have non-coronary aetiology.

If we exclude myocardial ischaemia and infarction, the most common causes of atypical chest pain are diseases related to gastrointestinal tract, chest wall syndromes, pericardial diseases, and vascular diseases; other less common diagnoses include pneumonia, pulmonary embolism, lung cancer, aortic aneurysm, myocarditis, stress-related cardiomyopathy (also called ‘Takotsubo’ syndrome), aortic stenosis, herpes zoster, and cardiac masses.5 After ruling-out acute myocardial infarction and other life-threatening conditions, usually related to cardiovascular compartment, the prognosis is generally very good.

Physicians usually refer these patients to further ambulatory diagnostic evaluations, aware that in about 10% of these cases specific diagnosis will not be reached.6

What is the differential diagnosis of chest pain wiki?

Differential diagnosis – Causes of chest pain range from non-serious to serious to life-threatening. In adults the most common causes of chest pain include: gastrointestinal (42%), coronary artery disease (31%), musculoskeletal (28%), pericarditis (4%) and pulmonary embolism (2%).

Other less common causes include: pneumonia, lung cancer, and aortic aneurysms. Psychogenic causes of chest pain can include panic attacks ; however, this is a diagnosis of exclusion. In children, the most common causes for chest pain are musculoskeletal (76-89%), exercise-induced asthma (4-12%), gastrointestinal illness (8%), and psychogenic causes (4%).

Chest pain in children can also have congenital causes.

What is the differential diagnosis of chest pain pubmed?

Abstract – In patients with chest pain somatic pain (thoracic wall pain) has to be differentiated from visceral pain (organ pain). History and careful physical examination are diagnostic in most cases. Presented are rare and not well-known diseases like valvular aortic stenosis, idiopathic hypertrophic subaortic stenosis and the mitral valve prolapse syndrome.

Not seldom they are masked by angina pectoris-like symptoms, although in general the coronary arteries are normal. In acute chest pain differential diagnostic considerations have to include lung embolism, acute pericarditis, spontaneous pneumothorax, acute dissecting aneurysm of the aorta and diseases of the gastrointestinal tract as well.

Only after exclusion of any organic cause the diagnosis of “effort syndrome” may be made.

What are the differentials for chest pain and fever?

Conditions that have fever and chest pain as symptoms bronchitis. pneumonia. myocarditis. pericarditis.